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Nakajima Y, Takahashi N, Kawabata K, Fujita K, Shiomi K, Sato M, Omata N, Kobayashi Y. Characteristics of Visual Cognition in Patients with Anoxic Encephalopathy: An Eye-tracking Study. Prog Rehabil Med 2024; 9:20240024. [PMID: 39081543 PMCID: PMC11284244 DOI: 10.2490/prm.20240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/17/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives : Despite the frequent occurrence of visual cognitive impairment after anoxic encephalopathy, only a few studies have analyzed gaze movements following encephalopathy. This study determined the visual cognitive characteristics of patients with anoxic encephalopathy using an eye-tracking system. Methods : This study included ten patients with anoxic encephalopathy and ten age/sex-matched controls. Factors for anoxic encephalopathy onset and brain imaging findings were extracted from medical records. An eye-tracking system was used to track eye movements during three visual search tasks (pop-out, serial search, and saliency) in patient and healthy control groups. The average target search time, number of saccades, and number of fixations to salient stimuli were compared. Results : Stagnant blood flow, observed in six of ten patients, was the most common cause of disease onset, four of whom exhibited hypoperfusion in bilateral occipital or parietal lobes on single-photon emission computed tomography. The patient group required longer search times during all visual search tasks and a higher number of saccades during pop-out and serial search tasks. However, no significant difference was observed between the two groups for the number of fixations to salient stimuli during the saliency task. Conclusions : Following anoxic encephalopathy, bottom-up (pop-out task) and top-down (serial search task) gaze control were considered impaired because of extensive parieto-occipital lobe damage after blood flow stagnation. Patients exhibited reduced top-down function for finding targets (serial search task) but relatively retain inhibitory function for salient stimuli (saliency task). Gaze analysis can be used to reveal the clinical characteristics of anoxic encephalopathy.
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Affiliation(s)
- Yuya Nakajima
- Department of Rehabilitation, Faculty of Health Science,
Fukui Health Science University, Fukui City, Japan
- Fukui Higher Brain Dysfunction Support Center, Fukui City,
Japan
| | - Nobuhiro Takahashi
- Department of Rehabilitation, Faculty of Health Science,
Fukui Health Science University, Fukui City, Japan
- Fukui Higher Brain Dysfunction Support Center, Fukui City,
Japan
| | - Kaori Kawabata
- Fukui Higher Brain Dysfunction Support Center, Fukui City,
Japan
- Graduate School of Health Science, Fukui Health Science
University, Fukui City, Japan
| | - Kazuki Fujita
- Graduate School of Health Science, Fukui Health Science
University, Fukui City, Japan
| | - Kakuichi Shiomi
- Department of Rehabilitation, Faculty of Health Science,
Fukui Health Science University, Fukui City, Japan
| | - Mamiko Sato
- Fukui Higher Brain Dysfunction Support Center, Fukui City,
Japan
- Department of Rehabilitation Medicine, Fukui General
Hospital, Fukui City, Japan
| | - Naoto Omata
- Graduate School of Health Science, Fukui Health Science
University, Fukui City, Japan
| | - Yasutaka Kobayashi
- Fukui Higher Brain Dysfunction Support Center, Fukui City,
Japan
- Graduate School of Health Science, Fukui Health Science
University, Fukui City, Japan
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Garces P, Antoniades CA, Sobanska A, Kovacs N, Ying SH, Gupta AS, Perlman S, Szmulewicz DJ, Pane C, Németh AH, Jardim LB, Coarelli G, Dankova M, Traschütz A, Tarnutzer AA. Quantitative Oculomotor Assessment in Hereditary Ataxia: Discriminatory Power, Correlation with Severity Measures, and Recommended Parameters for Specific Genotypes. CEREBELLUM (LONDON, ENGLAND) 2024; 23:121-135. [PMID: 36640220 PMCID: PMC10864420 DOI: 10.1007/s12311-023-01514-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Characterizing bedside oculomotor deficits is a critical factor in defining the clinical presentation of hereditary ataxias. Quantitative assessments are increasingly available and have significant advantages, including comparability over time, reduced examiner dependency, and sensitivity to subtle changes. To delineate the potential of quantitative oculomotor assessments as digital-motor outcome measures for clinical trials in ataxia, we searched MEDLINE for articles reporting on quantitative eye movement recordings in genetically confirmed or suspected hereditary ataxias, asking which paradigms are most promising for capturing disease progression and treatment response. Eighty-nine manuscripts identified reported on 1541 patients, including spinocerebellar ataxias (SCA2, n = 421), SCA3 (n = 268), SCA6 (n = 117), other SCAs (n = 97), Friedreich ataxia (FRDA, n = 178), Niemann-Pick disease type C (NPC, n = 57), and ataxia-telangiectasia (n = 85) as largest cohorts. Whereas most studies reported discriminatory power of oculomotor assessments in diagnostics, few explored their value for monitoring genotype-specific disease progression (n = 2; SCA2) or treatment response (n = 8; SCA2, FRDA, NPC, ataxia-telangiectasia, episodic-ataxia 4). Oculomotor parameters correlated with disease severity measures including clinical scores (n = 18 studies (SARA: n = 9)), chronological measures (e.g., age, disease duration, time-to-symptom onset; n = 17), genetic stratification (n = 9), and imaging measures of atrophy (n = 5). Recurrent correlations across many ataxias (SCA2/3/17, FRDA, NPC) suggest saccadic eye movements as potentially generic quantitative oculomotor outcome. Recommendation of other paradigms was limited by the scarcity of cross-validating correlations, except saccadic intrusions (FRDA), pursuit eye movements (SCA17), and quantitative head-impulse testing (SCA3/6). This work aids in understanding the current knowledge of quantitative oculomotor parameters in hereditary ataxias, and identifies gaps for validation as potential trial outcome measures in specific ataxia genotypes.
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Affiliation(s)
- Pilar Garces
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Chrystalina A Antoniades
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, OX3 9DU, UK
| | - Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Norbert Kovacs
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | - Sarah H Ying
- Department of Otology and Laryngology and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Perlman
- University of California Los Angeles, Los Angeles, CA, USA
| | - David J Szmulewicz
- Balance Disorders and Ataxia Service, Royal Victoria Eye and Ear Hospital, East Melbourne, Melbourne, VIC, 3002, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, VIC, 3052, Australia
| | - Chiara Pane
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Laura B Jardim
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica/Centro de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giulia Coarelli
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm U1127, CNRS UMR7225, Sorbonne Université, Paris, France
- Department of Genetics, Neurogene National Reference Centre for Rare Diseases, Pitié-Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Michaela Dankova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Andreas Traschütz
- Research Division "Translational Genomics of Neurodegenerative Diseases," Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Alexander A Tarnutzer
- Cantonal Hospital of Baden, Baden, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Terao Y, Tokushige SI, Inomata-Terada S, Miyazaki T, Kotsuki N, Fisicaro F, Ugawa Y. How do patients with Parkinson's disease and cerebellar ataxia read aloud? -Eye-voice coordination in text reading. Front Neurosci 2023; 17:1202404. [PMID: 37638315 PMCID: PMC10452879 DOI: 10.3389/fnins.2023.1202404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background The coordination between gaze and voice is closely linked when reading text aloud, with the gaze leading the reading position by a certain eye-voice lead (EVL). How this coordination is affected is unknown in patients with cerebellar ataxia and parkinsonism, who show oculomotor deficits possibly impacting coordination between different effectors. Objective To elucidate the role of the cerebellum and basal ganglia in eye-voice coordination during reading aloud, by studying patients with Parkinson's disease (PD) and spinocerebellar degeneration (SCD). Methods Participants were sixteen SCD patients, 18 PD patients, and 30 age-matched normal subjects, all native Japanese speakers without cognitive impairment. Subjects read aloud Japanese texts of varying readability displayed on a monitor in front of their eyes, consisting of Chinese characters and hiragana (Japanese phonograms). The gaze and voice reading the text was simultaneously recorded by video-oculography and a microphone. A custom program synchronized and aligned the gaze and audio data in time. Results Reading speed was significantly reduced in SCD patients (3.53 ± 1.81 letters/s), requiring frequent regressions to compensate for the slow reading speed. In contrast, PD patients read at a comparable speed to normal subjects (4.79 ± 3.13 letters/s vs. 4.71 ± 2.38 letters/s). The gaze scanning speed, excluding regressive saccades, was slower in PD patients (9.64 ± 4.26 letters/s) compared to both normal subjects (12.55 ± 5.42 letters/s) and SCD patients (10.81 ± 4.52 letters/s). PD patients' gaze could not far exceed that of the reading speed, with smaller allowance for the gaze to proceed ahead of the reading position. Spatial EVL was similar across the three groups for all texts (normal: 2.95 ± 1.17 letters/s, PD: 2.95 ± 1.51 letters/s, SCD: 3.21 ± 1.35 letters/s). The ratio of gaze duration to temporal EVL was lowest for SCD patients (normal: 0.73 ± 0.50, PD: 0.70 ± 0.37, SCD: 0.40 ± 0.15). Conclusion Although coordination between voice and eye movements and normal eye-voice span was observed in both PD and SCD, SCD patients made frequent regressions to manage the slowed vocal output, restricting the ability for advance processing of text ahead of the gaze. In contrast, PD patients experience restricted reading speed primarily due to slowed scanning, limiting their maximum reading speed but effectively utilizing advance processing of upcoming text.
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Affiliation(s)
- Yasuo Terao
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Mitaka, Japan
| | - Shin-ichi Tokushige
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Satomi Inomata-Terada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Mitaka, Japan
| | - Tai Miyazaki
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Naoki Kotsuki
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Francesco Fisicaro
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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Tokushige SI, Matsumoto H, Matsuda SI, Inomata-Terada S, Kotsuki N, Hamada M, Tsuji S, Ugawa Y, Terao Y. Early detection of cognitive decline in Alzheimer's disease using eye tracking. Front Aging Neurosci 2023; 15:1123456. [PMID: 37025964 PMCID: PMC10070704 DOI: 10.3389/fnagi.2023.1123456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Patients with Alzheimer's disease (AD) are known to exhibit visuospatial processing impairment, as reflected in eye movements from the early stages of the disease. We investigated whether the pattern of gaze exploration during visual tasks could be useful for detecting cognitive decline at the earliest stage. Methods Sixteen AD patients (age: 79.1 ± 7.9 years, Mini Mental State Examination [MMSE] score: 17.7 ± 5.3, mean ± standard deviation) and 16 control subjects (age: 79.4 ± 4.6, MMSE score: 26.9 ± 2.4) participated. In the visual memory task, subjects memorized presented line drawings for later recall. In the visual search tasks, they searched for a target Landolt ring of specific orientation (serial search task) or color (pop-out task) embedded among arrays of distractors. Using video-oculography, saccade parameters, patterns of gaze exploration, and pupil size change during task performance were recorded and compared between AD and control subjects. Results In the visual memory task, the number of informative regions of interest (ROIs) fixated was significantly reduced in AD patients compared to control subjects. In the visual search task, AD patients took a significantly longer time and more saccades to detect the target in the serial but not in pop-out search. In both tasks, there was no significant difference in the saccade frequency and amplitude between groups. On-task pupil modulation during the serial search task was decreased in AD. The number of ROIs fixated in the visual memory task and search time and saccade numbers in the serial search task differentiated both groups of subjects with high sensitivity, whereas saccade parameters of pupil size modulation were effective in confirming normal cognition from cognitive decline with high specificity. Discussion Reduced fixation on informative ROIs reflected impaired attentional allocation. Increased search time and saccade numbers in the visual search task indicated inefficient visual processing. Decreased on-task pupil size during visual search suggested decreased pupil modulation with cognitive load in AD patients, reflecting impaired function of the locus coeruleus. When patients perform the combination of these tasks to visualize multiple aspects of visuospatial processing, cognitive decline can be detected at an early stage with high sensitivity and specificity and its progression be evaluated.
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Affiliation(s)
- Shin-ichi Tokushige
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Neurology, Kyorin University, Tokyo, Japan
| | | | | | | | - Naoki Kotsuki
- Department of Neurology, Kyorin University, Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Yasuo Terao
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Tokyo, Japan
- *Correspondence: Yasuo Terao,
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Oh AJ, Chen T, Shariati MA, Jehangir N, Hwang TN, Liao YJ. A simple saccadic reading test to assess ocular motor function in cerebellar ataxia. PLoS One 2018; 13:e0203924. [PMID: 30403759 PMCID: PMC6221255 DOI: 10.1371/journal.pone.0203924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
Cerebellar ataxia is a neurological disorder due to dysfunction of the cerebellum that affects coordination of fine movement, gait, and balance. Although ataxic patients commonly exhibit abnormal eye movement and have difficulties with saccadic reading, quantification of ocular motor abilities during reading in the clinical setting is rarely done. In this study, we assess visual performance with simple reading tests that can be used in the clinical setting and performed video infrared oculography in 11 patients with hereditary or acquired cerebellar ataxia and 11 age-matched controls. We found that compared with controls, ataxic patients read significantly slower on regularly and irregularly spaced 120 single-digit number reading tasks (read aloud) (p = 0.02 for both) but not on a word reading task (read silently), although there was large variability on the word reading task. Among the 3 reading tasks, the regularly spaced number reading task had the greatest difference (44%) between ataxic patients and controls. Analysis of oculography revealed that ataxic patients had slower reading speeds on the regularly spaced number reading task because of significantly higher saccade and fixation counts, impairment of small amplitude progressive saccades as well as large amplitude, line-changing saccades, greater fixation dispersion, and irregularity of scan paths and staircase gaze patterns. Our findings show that infrared oculography remains the gold standard in assessment of ocular motor difficulties during reading in ataxic patients. In the absence of this capability in the clinical setting, a simple 120 regularly spaced single-digit saccadic number reading test, which most patients can perform in less than 2 minutes, can be a possible biomarker for ocular motor abilities necessary for reading.
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Affiliation(s)
- Angela Jinsook Oh
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tiffany Chen
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mohammad Ali Shariati
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Naz Jehangir
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Thomas N. Hwang
- Department of Ophthalmology, Kaiser Permanente Redwood City Medical Center, Redwood City, California, United States of America
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Neurology, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Effect of subthalamic nucleus deep brain stimulation on visual scanning. Clin Neurophysiol 2018; 129:2421-2432. [DOI: 10.1016/j.clinph.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/12/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
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Okahara Y, Takano K, Komori T, Nagao M, Iwadate Y, Kansaku K. Operation of a P300-based brain-computer interface by patients with spinocerebellar ataxia. Clin Neurophysiol Pract 2017; 2:147-153. [PMID: 30214988 PMCID: PMC6123944 DOI: 10.1016/j.cnp.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/12/2017] [Accepted: 06/24/2017] [Indexed: 11/16/2022] Open
Abstract
Objective We investigated the efficacy of a P300-based brain-computer interface (BCI) for patients with spinocerebellar ataxia (SCA), which is often accompanied by cerebellar impairment. Methods Eight patients with SCA and eight age- and gender-matched healthy controls were instructed to input Japanese hiragana characters using the P300-based BCI with green/blue flicker. All patients depended on some assistance in their daily lives (modified Rankin scale: mean 3.5). The chief symptom was cerebellar ataxia; no cognitive deterioration was present. A region-based, two-step P300-based BCI was used. During the P300 task, eight-channel EEG data were recorded, and a linear discriminant analysis distinguished the target from other nontarget regions of the matrix. Results The mean online accuracy in BCI operation was 82.9% for patients with SCA and 83.2% for controls; no significant difference was detected. Conclusion The P300-based BCI was operated successfully not only by healthy controls but also by individuals with SCA. Significance These results suggest that the P300-based BCI may be applicable for patients with SCA.
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Affiliation(s)
- Yoji Okahara
- Systems Neuroscience Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation for Persons with Disabilities, Tokorozawa, Saitama 359-8555, Japan.,Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba 260-8670, Japan
| | - Kouji Takano
- Systems Neuroscience Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation for Persons with Disabilities, Tokorozawa, Saitama 359-8555, Japan
| | - Tetsuo Komori
- Department of Neurology, National Hakone Hospital, Odawara, Kanagawa 250-0032, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba 260-8670, Japan
| | - Kenji Kansaku
- Systems Neuroscience Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation for Persons with Disabilities, Tokorozawa, Saitama 359-8555, Japan.,Brain Science Inspired Life Support Research Center, The University of Electro-Communications, Chofu, Tokyo 182-8585, Japan
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Abstract
PURPOSE OF REVIEW Abnormalities of oculomotor control accompany the pathological changes underlying many neurodegenerative diseases. Clinical examination of eye movements can contribute to differential diagnosis, whereas quantitative laboratory measures can provide detailed insight into the disease process. In this review of eye movements in neurodegenerative disease, we summarise recent empirical findings and conceptual advances. RECENT FINDINGS Oculomotor researchers continue to be particularly prolific in studying Parkinson's disease but there is also substantial activity in Alzheimer's disease and spinocerebellar ataxia. Interesting findings have been reported in Huntington's, motor neuron disease, and glaucoma. Most studies report laboratory-based investigations but useful progress in clinical description continues to be made. SUMMARY Eye movements remain an active field of investigation across a variety of neurodegenerative conditions. Progress continues to be made at the clinical level as well by using laboratory techniques.
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Affiliation(s)
- Michael R MacAskill
- aNew Zealand Brain Research Institute bDepartment of Medicine, University of Otago cDepartment of Neurology, Christchurch Hospital, Christchurch, New Zealand
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Matsumoto H. A neurophysiological examination of basal ganglia and cerebellum. Clin Neurophysiol 2016; 127:1007-1008. [DOI: 10.1016/j.clinph.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/05/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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